title: 'Testing Together Challenges the Relationship': Consequences of HIV Testing as a Couple in a High HIV Prevalence Setting in Rural South Africa.
abstract: We conducted qualitative individual and combined interviews with couples to explore their experiences since the time of taking an HIV test and receiving the test result together, as part of a home-based HIV counselling and testing intervention.
  
  
  
  This study was conducted in October 2011 in rural KwaZulu-Natal, South Africa, about 2 years after couples tested and received results together. Fourteen couples were purposively sampled: discordant, concordant negative and concordant positive couples.
  
  
  
  Learning about each other's status together challenged relationships of the couples in different ways depending on HIV status and gender. The mutual information confirmed suspected infidelity that had not been discussed before. Negative women in discordant partnerships remained with their positive partner due to social pressure and struggled to maintain their HIV negative status. Most of the couple relationships were characterized by silence and mistrust. Knowledge of sero-status also led to loss of sexual intimacy in some couples especially the discordant. For most men in concordant negative couples, knowledge of status was an awakening of the importance of fidelity and an opportunity for behaviour change, while for concordant positive and discordant couples, it was seen as proof of infidelity. Although positive HIV status was perceived as confirmation of infidelity, couples continued their relationship and offered some support for each other, living and managing life together. Sexual life in these couples was characterized by conflict and sometimes violence. In the concordant negative couples, trust was enhanced and behaviour change was promised.
  
  
  
  Findings suggest that testing together as couples challenged relationships in both negative and positive ways. Further, knowledge of HIV status indicated potential to influence behaviour change especially among concordant negatives. In the discordant and concordant positive couples, traditional gender roles exposed women's vulnerability and their lack of decision-making power.
authors.affiliation: Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa ; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden ; Department of infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Hanani
authors.initials: H
authors.lastname: Tabana
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
authors.forename: Birgitta
authors.initials: B
authors.lastname: Rubenson
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
authors.forename: Anna Mia
authors.initials: AM
authors.lastname: Ekström
authors.forename: Anna
authors.initials: A
authors.lastname: Thorson
mesh_terms: D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D015528:HIV Seroprevalence; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D012747:Sexual Partners; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult